Modupe Agbeyomi, DNP, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F09180151 Issued in GA

Practice address

13 Corporate Blvd NE Ste 200
Brookhaven, GA 30329-1900

Phone

(770) 557-1079

Fax

(770) 872-6621

NPI assigned

Sep 28, 2018

Last updated

Nov 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anemonefish Inpatient Services LLC

  • Internal Medicine Physician
  • Covington, GA
  • NPI 1033514716

  Multi-Specialty

  Medicare reassignment NPD
• Lifeguide, Inc

  dba Lifeguide Family Practice LLC

  • Primary Care Clinic/Center
  • Lilburn, GA
  • NPI 1508078973

  Multi-Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1245715903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 CORPORATE BLVD NE STE 200",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303291900",
            "telephone_number": "770-557-1079",
            "fax_number": "770-872-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 CORPORATE BLVD NE STE 200",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303291900",
            "telephone_number": "770-557-1079",
            "fax_number": "770-872-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBEYOMI",
        "first_name": "MODUPE",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Migrant Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "F09180151",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "F09180151",
            "primary": false
        },
        {
            "code": "363LS0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, School",
            "state": "GA",
            "license": "F09180151",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F09180151",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garcia Abraham
• Hayatu Zeinu Abrar
• Amar M Aburas, CSA
• Chidozie Adindu, RBT
• Pearl Afetornu, RBT
• John Frederick Agel Jr., MD
• Agilitas USA, Inc (Results Physiotherapy)
• Daniele Albert, MS, LAT, ATC
• Rose Alcime, RBT
• Jamilet Cristy Alegria, M.D.

• Family Nurse Practitioner in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.